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EVIDENCE-BASED REHABILITATION INTERVENTIONS FOR ADOLESCENTS WITH SCHIZOPHRENIA SPECTRUM DISORDERS – FROM LITERATURE REVIEW TO PRACTICE. Kiki Metsäranta, RN, Nurse Manager Anna Laine, RN, BHSc. Breaking barriers, The Nordic Conference of Mental Health Nursing 11 – 13 September 2013.
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EVIDENCE-BASED REHABILITATION INTERVENTIONS FORADOLESCENTS WITH SCHIZOPHRENIA SPECTRUMDISORDERS – FROM LITERATURE REVIEW TO PRACTICE Kiki Metsäranta, RN, Nurse Manager Anna Laine, RN, BHSc Breaking barriers, The Nordic Conference of Mental Health Nursing 11 – 13 September 2013
SHORT FACTS OF HUS kiki.metsaranta@hus.fi
BACKGROUND • Adolescent Psychiatry Rehabilitation Unit is under development • from in-patient to out-patient • out patient rehabilitation services have been centralized • for adolescents with psychotic disorders and/or neuropsychiatric problems • impaired functionality • Need for • evidence-based care methods to improve adolescent psychiatric rehabilitation • safe and effective treatments kiki.metsaranta@hus.fi
main Focus on developing work • We decided to focus on Schizophrenia • one of the most severe mental disorder appearing typically in the late adolescence or early adulthood. • a chronic disorder • impairing patients social and cognitive functioning • expensive diseases economically and humanely kiki.metsaranta@hus.fi
THE AIMS • To do literature review for evidence-based interventions for adolescents with schizophrenia spectrum disorders • To find out how this knowledge can be tailored for daily practice in adolescent psychiatric rehabilitation unit kiki.metsaranta@hus.fi
LITERATUREREVIEW • An electronic search February 2013 • CINAHL, Pubmed and PsycINFO • inclusion criteria • English language • adolescent population • intervention included • diagnosis of schizophrenia spectrum disorders • empirical research • studies published after the January 1st 2000. kiki.metsaranta@hus.fi
RESULTS • 1032 initially identified abstracts • 166 articles were retrieved • 12 articles were included based to inclusion criteria. kiki.metsaranta@hus.fi
TARGET GROUP OF INTERVENTION INTERVENTION • Cognitive rehabilitation therapy (CRT) • Computer- assisted, CARC (based on CRT) • Cognitive behavioral therapy (CBT) • EPP (Early Psychosis Program) • Intensive community management • Family focused intervention • Telepsychiatry • In- patient treatment – restrain, holding, seclusion, time-out • 5 individual • 3 integrative – family, patient • 2 in-patient (individual) • 1 family • 1 group intervention kiki.metsaranta@hus.fi
CRT • training programme • cognitive differentation, attention, memory and social perception • may have a positive effect on cognition and cognitive flexibility CBT • focused on the present • time- limited • problem- solving oriented • patients learn specific skills INTERVENTION - COGNITIVE kiki.metsaranta@hus.fi
INTERVENTION - COGNITIVE EPP (Calgary Early Psychosis Program) • case management, psychiatric management and medication, strategies, cognitive-behavior therapy, group therapy and family interventions
INTERVENTION – CASE STUDIES Intensive community management • the family's determination to avoid hospitalization • work of the families concerned • intensive community resources • ready availability of inpatient beds Telepsychiatry • interactive sessions by teleconferencing • Family-focused intervention • community based • family-centered • self-management • group sessions 30.9.2014 kiki.metsaranta@hus.fi
Intervention- in-patient In - patient treatment – restrain, holding, seclusion, time-out • high risk group of restrain during inpatient treatment 30.9.2014 kiki.metsaranta@hus.fi
WHAT WILL CHANGE? kiki.metsaranta@hus.fi
CHOOSING AND IMPLEMENTING NEW INTERVENTIONS Cognitive remediation treatment – CRT Cognitive behavioral therapy – CBT Social Cognition and Interaction Training (SCIT) Acceptance and commintment therapy (ACT)
Importance of medical treatment – monitoring and motivating Preventing and minimize risks of relapses and substance abuse AND THAT WAS NOT ALL /BONUS MATERIAL /WHAT ELSE?
ENABLERS OF THE DEVELOPMENT PROJECT Need for evidence based rehabilitation Manager involvement and support Importance to improve rehabilitation Easy to use
CHALLENGES Clear implementation plan is needed • Training • Follow-up • Feedback • Administration´s support Resource • Time, support Barriers must be verify • Weak collaboration between different professional level • Resistance
WHAT WE HAVE LEARNED Support from administration is important Nurses´ professional indentity have increased We can make improvement if we want it
KIITOSÞAKKA ÞÉRTACKTHANK YOU kiki.metsaranta@hus.fi